Cancer Survivors and Advances in Treatment

June 3 – Cathy Smithwick, now 67, has faced breast cancer and ovarian cancer for over 20 years, relying on targeted therapies that leverage her immune system, along with chemotherapy and hormone treatments.

Michelle Vacca, who recently turned 59, has lived with lung cancer for nearly a decade and is currently doing well on an experimental drug that targets a specific tumor mutation.

They are part of an increasing number of Americans managing cancer, thanks to ongoing research that continues to reveal the biological basis of the disease and leads to new drugs aimed at a tumor’s genetic profile.

The American Cancer Society estimates that around 18 million Americans who have experienced cancer are still alive today.

Currently, a record 70% of cancer patients survive for at least five years, a significant rise from the less than 50% survival rate in the 1970s and 63% in the mid-1990s, thanks to the emergence of drugs aimed at specifically targeting cancer cells.

Chemotherapy, which affects all fast-growing cells, remains a central part of oncology treatment but was historically the only choice for many cancer patients.

Rebecca Siegel, head of surveillance research at the cancer organization, noted, “It’s taken decades for us to really understand the biology of cancer.” She is optimistic that survival rates will continue to improve, even as cancer—more prevalent in older populations—remains the second leading cause of death after heart disease.

A recent American Society of Clinical Oncology meeting in Chicago highlighted a study revealing that cancer deaths among people aged 15 to 49 have decreased by 25% since 1990. The meeting also showcased results from trials of new life-extending drugs for pancreatic cancer, skin cancer, and blood cancers.

Cancer develops when mutations in cellular DNA lead to uncontrolled cell growth and division. These mutations can be caused by exposure to factors like tobacco or UV rays, although some cases involve inherited mutations.

For a new drug to gain regulatory approval, it must prove to be both safe and effective, often measured by tumor shrinkage rather than overall survival rates. Notably, fewer than a third of recently approved cancer drugs have shown a clear ability to extend patients’ lives.

Success rates are improving partly due to clinical trials that select patients based on specific genetic markers, nearly doubling the success rate compared to unselected trials.

Newer treatments, like Revolution Medicines’ daraxonrasib, target variants of the RAS gene that contribute to tumor growth and help patients overcome resistance to standard therapies, according to Dr. Vincent Chung, a pancreas cancer specialist at City of Hope.

He commented, “This is how you have patients that are living with cancer… If you’ve been on a targeted therapy, you’re likely to be more responsive to older chemotherapy again.”

LIVING, BUT WITH CANCER

Smithwick, a former management consultant in Silicon Valley, was diagnosed with breast cancer in 2005. Her tumor tested positive for a protein called HER2—present in about 25% of breast cancers—and she received Roche’s Herceptin, one of the pioneering antibody drugs designed to inhibit a cancer-causing protein.

She was tested for the BRCA1 gene mutation, linked to cancer risk, only after her sister received a breast cancer diagnosis years later.

In 2010, following surgery, Smithwick was diagnosed with ovarian cancer. When her cancer showed resistance to a drug, other treatments were attempted, but she had an allergic reaction to platinum-based chemotherapy and could no longer pursue that option.

Currently, she takes an estrogen-targeting pill, and if her tumor grows significantly, her doctors at Kaiser Permanente plan to perform a biopsy for other genetic testing.

“They will test for all available markers,” Smithwick said, reflecting on her adventurous spirit as she recently completed a 4-mile hike in Bhutan and is planning her fourth trip to Kenya this summer. “Meanwhile, I am living my life.”

Vacca, who manages an office in Orange County, California, was diagnosed with lung cancer at an early stage during an unrelated chest X-ray. After her surgery, a biopsy revealed an EGFR mutation, which led to treatment with AstraZeneca’s tyrosine kinase inhibitor Tagrisso; however, the cancer returned.

After experiencing a rash from another drug that became infected, City of Hope discovered her cancer had the rare EGFR 20 insertion mutation, resulting in her enrollment in a three-year trial for a drug known as CLN-081.

“It’s still working for me,” Vacca shared. “I don’t really have any side effects… It hasn’t stopped me from going to K-pop concerts.”

Dr. Saro Armenian, director at City of Hope’s survivorship program, mentioned the center is intensifying its research efforts to better understand the experiences of cancer survivors, while also acknowledging that patients can still face serious prognoses.

Dr. Julie Gralow, ASCO’s chief medical officer, stated, “We’re going to have to look at the full genomic profile of every cancer.”